- The document provides guidelines for the management of avulsed permanent teeth, dividing treatment into emergency and definitive care stages. - Emergency treatment includes finding the tooth, cleaning it, and replanting or storing it in appropriate media like saline or coconut water until replantation. Definitive care involves examination, root canal treatment, antibiotics, and follow-up based on whether the tooth's root is open or closed. - Prognosis and treatment depends on the dry time of an avulsed tooth - teeth dry less than 60 minutes have a better chance of survival than those dry over 60 minutes. Multiple storage media are discussed for temporary transport of avulsed teeth prior to replantation.

1. GUIDELINES FOR THE MANAGEMENT
OF TRAUMATIC DENTAL
INJURIES.II.AVULSION OF PERMENANT
TEETH
(JOURNAL CLUB)
Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett
F, Bourguignon C, DiAngelis A, Hicks L, Sigurdsson A, Trope M, Tsukiboshi
M, von Arx T
Dent Traumatol.2007 Jun;23(3):130-6

2. INTRODUCTION

3. FIRST AID FOR AVULSED TEETH
• Keep patient calm
• Find the tooth
• If dirty,wash it,try to reposition
• If not storage medium
• Seek emergency dental treatment

4. SAVE A TOOTH

5. GUIDELINES FOR THE CLINICIAN
• Clinical Examination
• Radiographic Examination
• Sensibility Test
• Patient Instructions

6. TREATMENT GUIDELINES FOR
AVULSED PERMENANT TEETH WITH
CLOSED APEX
• Clinical Situation:replanted Prior To Patient
Arrives
• Inspect
• Administer Systemic Antibiotics
• Tetanus Coverage
• RCT
• Patient Instructions
• Follow Up

7. • Clinical Situation: tooth Kept In storage media
• Clean
• Systemic Antibiotics
• Tetanus Coverage
• RCT
• Patient Instructions
• Follow Up

8. Extra oral dry time more than 60 min
• Prognosis
• Technique
Cleaning
RCT
Examine the alveolar socket
Immerse in 2% sodium flouride for 20 min
Replant
Stabilize 4 weeks
• Antibiotics
• Patient instruction
• Follow up

9. TREATMENT GUIDELINES FOR
AVULSED PERMANENT TEETH WITH
OPEN APEX
• Clinical Condition: Already Replanted
• Clean The Area
• Antibiotics
• Physician Referal
• Procedure
• Patient Instructions
• Follow Up

10. TOOTH KEPT IN STORAGE MEDIUM
• Clean The Tooth
• Examine The Socket
• Treatment Procedure
• Antibiotic Coverage
• Physician Referal
• Procedure
• Patient Instructions
• Follow Up

11. EXTRA ORAL TIME LONGER THAN 60
MIN
• Prognosis
• Technique:
• Cleaning
• Rct
• Immerse In 2% NaF
• Stabilize 4 weeks
• Antibiotic Coverage
• Patient Instruction
• Follow Up

12. FOLLOW UP PROCEDURE FOR
AVULSED PERMENAT TEETH
• RCT
• Clinical Control
Monitored 1,3,6,12 months,yearly)
• Favourable Outcome
• Unfavourable Outcome
• Splinting

13. Closed Apex
Satisfactory outcome
• Clinical : asymptomatic,
normal mobility, normal sound
on percussion.
• Radiographic : no
periradicular radiolucencies
indicative of progressive
external inflammatory root
resorption
Unsatisfactory outcome
• Clinical : symptomatic and/or
high pitch percussion sound.
• Radiographic : Periradicular
radiolucencies in the root and
bone or radiographic
replacement of the root with
bone

14. Open Apex
Satisfactory outcome
• Clinical : asymptomatic,
normal mobility and
eruption pattern, normal
sound on percussion.
Positive sensitivity test.
• Radiographic : Continued
root development,
Unsatisfactory Outcome
• Clinical : symptomatic and / or
high pitched percussion sound.
Tooth in infra occlusion.
• Radiographic : As with closed
apex. Root fails to develop, the
pulpal lumen does not change
in size.

15. CRITICAL EVALUATION
POSITIVE:
• A good outline about the management of the
avulsed condition
• Will be useful for even general dental
practioners
NEGATIVES:
• Complete explanation couldn’t be done as it is
a guidelines

16. CROSS
REFERENCES

19. Treatment of avulsed teeth is divided in 2 main
stages:
• 1. emergency treatment that should be provided
as soon as possible;
• 2. definitive treatment based on a clinical and
radiographic follow-up examination.

22. • Saline- Pileggi Et Al 1995,Lauer Et Al 1997
• Gatorade- Harkacz Et Al,1981
• Saliva- Sangappa,2014
• Coconut Water- Gopikrishna 2008, Moreira-neto
2009
• Milk- Moreire-Neto 2009,Souza Et al 2011
• Egg White- Siddiqui 2014,Poi Wr 2013,
Adnan,2014
• Morusrubra- Malhotran 2011
• Saliva Offinalis(herb)- Adnan,2014
• Custodial- Alacam Et Al 1996

23. • Honey Milk- Siddiqui 2014(better Than Fresh
Milk), Nozari A 2013(HBSS)
• Probiotics- Gopikrishna 2008
• Patients Own Serum- Thonner-Sangappa 2014
• Ascorbic Acid- Bazmi Ba 2013, Ishikawa 2004
• Culture Medium- Lekic Et Al-1998
• Conditioned Medium- Udoye Ci 2012
• HBSS- John H Hanks 1975-Siddique 2014,Krasner
1992
• Emdogain- Mc Donald 2011,Scilean2007
• Viaspan- Trope 1997,Hupp JG1998

24. • Green Tea Extracts- Hwang And Jung Et Al
• Growth Factors- Ashkenazi M 2000
• Milk- Thomas T 2008 ,Blomlof 1981
• Milk Powder- Siddique E 2014
• Propolis- Martin and Pileggi 2004
• Tap water-unacceptable- Mackie 1992
• Normal saline- Cvek 1974

35. CLINICAL MANAGEMENT
OPEN APEX C;LOSED APEX
20M
IN
20-
60MIN
>60
MIN
20M
IN
20-
60MIN
>60
MIN
DISINFEC
TION &
REIMPLA
NTATION
HBSS
DISINFECTIO
N
REIMPLANT
ENDODONTIC
TREATMENT
SODIUM
FLOURIDE
HBSS
DISINFECTION
REIMPLANT
REIMPLA
NTATION
HBSS
DISINFECTIO
N
REIMPLANT
ENDODONTIC
TREATMENT
SODIUM
FLOURIDE
HBSS
DISINFECTION
REIMPLANT
VIABLE VIABLE/COMPRO
MISED
NON -VIABLE VIABLE
VIABLE/COMPRO
MISED
NON- VIABLE
RE-
IMPL
ANTE
D
RE-
IMPL
ANTE
D
FLEXIBLE SPLINTING
SYSTEMIC ANTIBIOTICS
TETANUS PROTECTION
PATIENT INSTRUCTION
ROOT CANAL TREATMENT
ANESTHESIA
ANTIBIOTICS
PATIENT INSTRUCTIONS
ENDODONTIC CONSIDERATIONS
FOLLOW UP-4W,3M,6M,1Y
TOOTH LOSS

36. IMPORTANCE IN PEDIATRIC
DENTISTRY
• Always expect the unexpected

37. THANK YOU